Provider Demographics
NPI:1508335696
Name:CLARKSVILLE MIDWIFERY, LLC
Entity Type:Organization
Organization Name:CLARKSVILLE MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:210-896-2241
Mailing Address - Street 1:1477 TINY TOWN RD STE 252
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7202
Mailing Address - Country:US
Mailing Address - Phone:931-820-2646
Mailing Address - Fax:931-241-5431
Practice Address - Street 1:1477 TINY TOWN RD STE 252
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7202
Practice Address - Country:US
Practice Address - Phone:931-820-2646
Practice Address - Fax:931-241-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty